AFFIDAVIT

I………………………………………………………………………………………………….

ID-Number…………………………………………. Age ………………..

Residing address ………………………………………………………………….

Working address ……………………………………………………………………..

Tel ………………………..(w) ……………………………(h) ……………………………(cell)

Declare under oath in English / confirm in English –

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I am familiar with, and understand the contents of this declaration. I have no objection/have objection
to taking the prescribed oath. I consider the prescribed oath as binding to my conscience.

Place: ………………………………….. Date: ………………………..

Time: ……………………………………

Signature: ………………………………………

I certify that the above statement was taken from me and that the deponent has acknowledge that
he/she knows and understands the contents of the statement. The statement was sworn to/affirmed
before me and deponents signature/mark/thumb print was placed thereon in my presence.

At: …………………………………on ………………………………at ……………………….

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Commissioner of Oaths

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Force number/Rank/Name